Efficacy of oral versus intravenous N-acetylcysteine in acetaminophen overdose: results of an open-label, clinical trial.
We compared the clinical course of pediatric patients (n = 25) with acetaminophen poisoning treated with an investigational intravenous preparation of N-acetylcysteine (IV-NAC) with that of historical control subjects (n = 29) treated with conventional oral NAC (O-NAC) therapy. Patients received IV-NAC for 52 hours; historical control subjects received O-NAC (72 hours). There were no significant intergroup differences between treatment groups in age (15.5 vs 15.9 years), gender (88% vs 90% female) or distribution of risk categories (probable risk, 12 vs 15; high risk; 13 vs 14). The peak prothrombin time was significantly higher in the IV-NAC group (14.2 vs 13.6 seconds; p = 0.048). Mean treatment delay was significantly longer in the IV-NAC group (14.4 vs 10.4 hours; p = 0.001). Hepatoxicity was noted in two (8.0%) patients in the IV-NAC treatment group and two (6.9%) patients in the O-NAC group. All patients recovered. Our results indicate that 52 hours of intravenous NAC is as effective as 72 hours of oral NAC.
Perry
H E
HE
Division of Emergency Medicine, Children's Hospital, Boston, Massachusetts, USA.
Shannon
M W
MW
D000082:Acetaminophen / Q000009:adverse effects*; D000111:Acetylcysteine / Q000008:administration & dosage* / Q000627:therapeutic use; D000284:Administration, Oral; D000293:Adolescent; D018712:Analgesics, Non-Narcotic / Q000009:adverse effects*; D056486:Chemical and Drug Induced Liver Injury / Q000188:drug therapy / Q000209:etiology; D062787:Drug Overdose / Q000188:drug therapy; D015507:Drugs, Investigational / Q000627:therapeutic use; D005260:Female; D016166:Free Radical Scavengers / Q000008:administration & dosage* / Q000627:therapeutic use; D006801:Humans; D007275:Injections, Intravenous; D008297:Male; D018709:Statistics, Nonparametric
D018712:Analgesics, Non-Narcotic; D015507:Drugs, Investigational; D016166:Free Radical Scavengers; D000082:Acetaminophen; D000111:Acetylcysteine